Percutaneous Nephrolithotomy in the United Kingdom: Results of a Prospective Data Registry

Abstract

BackgroundPercutaneous nephrolithotomy (PCNL) is commonly used in the management of large upper renal tract stones. It is highly effective but carries a greater risk of significant morbidity than less invasive treatment options such as ureteroscopy or extracorporeal shock wave lithotripsy. ObjectiveEvaluate the current practice and outcomes of PCNL using a national prospective data registry. Design, setting, and participantsAll surgeons undertaking PCNL in the United Kingdom were invited to submit data to an online registry. MeasurementsEffectiveness was assessed by stone-free rates and safety according to complications including blood transfusion, fever, and sepsis rates. Results and limitationsSince January 2010, data on 987 patients who had 1028 PCNL procedures were collected. A total of 299 of 1012 procedures (30%) were for staghorn calculi, 299 (30%) for stones >2cm, 329 (33%) for stones 1–2cm, and 89 (9%) for stones <1cm. There were no significant differences in rates of failed access or complications according to whether a urologist or radiologist obtained renal access. There was a nonsignificant trend to a higher transfusion rate with balloon dilatation (7 of 222 [3.2%]) compared with serial dilatation (2 of 245 [0.8%]) of the renal tract (p=0.093). Totally tubeless procedures were not associated with higher complication rates but did lead to a significant reduction in median length of stay (3 d vs 1.5 d; p<0.0001). Intraoperatively, 78% of patients were believed to be stone free, which was confirmed in 68% with postoperative imaging. Blood transfusion was required in 24 of 968 patients (2.5%). The incidence of postoperative fever was 16% and of sepsis was 2.4%. ConclusionsThe PCNL data registry is a unique resource providing vital information on current practice and critical outcome data. Using the registry, endourologists can audit their practice against national outcome data for this benchmark procedure. It will help surgeons counsel patients during consent for this complex endourologic procedure about the possible outcome in their hands.